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<%@include file="../header.jsp"%>
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<div id="content-outer">
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<div id="content">


<div id="page-heading"><h1>Form Pengajuan Beasiswa</h1></div>


<table border="0" width="100%" cellpadding="0" cellspacing="0" id="content-table">
<tr>
	<th rowspan="3" class="sized"><img src="../images/shared/side_shadowleft.jpg" width="20" height="300" alt="" /></th>
	<th class="topleft"></th>
	<td id="tbl-border-top">&nbsp;</td>
	<th class="topright"></th>
	<th rowspan="3" class="sized"><img src="../images/shared/side_shadowright.jpg" width="20" height="300" alt="" /></th>
</tr>
<tr>
	<td id="tbl-border-left"></td>
	<td>
	<!--  start content-table-inner -->
	<div id="content-table-inner">

	<table border="0" width="100%" cellpadding="0" cellspacing="0">
	<tr valign="top">
	<td>


		<!-- start id-form -->
                <form action="tambahPengajuanBeasiswa?status=submit&&idBeasiswa=${idBeasiswa}" method="POST" enctype="multipart/form-data">
		<table border="0" cellpadding="0" cellspacing="0"  id="id-form">
		<tr>
			<th valign="top">Nama Ayah:</th>
			<td><input type="text" name="namaAyah" class="inp-form" /></td>
			<td></td>
		</tr>
                <tr>
			<th valign="top">Pekerjaan Ayah:</th>
			<td><input type="text" name="pekerjaanAyah" class="inp-form" /></td>
			<td></td>
		</tr>
                <tr>
			<th valign="top">Nama Ibu:</th>
			<td><input type="text" name="namaIbu"  class="inp-form" /></td>
			<td></td>
		</tr>
                <tr>
			<th valign="top">Pekerjaan Ibu:</th>
			<td><input type="text" name="pekerjaanIbu" class="inp-form" /></td>
			<td></td>
		</tr>
		<tr>
			<th valign="top">Gaji Orang Tua:</th>
			<td><input type="text" name="gajiOrangtua" class="inp-form-error" /></td>
			<td>
			<div class="error-left"></div>
			<div class="error-inner">Wajib Diisi.</div>
			</td>
		</tr>
		<tr>
			<th valign="top">Waktu Pengajuan :</th>
			
			<td> <input type="text" name="waktuPengajuan" id="tanggalMulai" class="inp-form" /></td>
		</tr>
		
		<tr>
			<th valign="top">Rek. Listrik per Bulan:</th>
			<td><input type="text" name="rekListrik" class="inp-form-error" /></td>
			<td>
			<div class="error-left"></div>
			<div class="error-inner">Wajib Diisi.</div>
			</td>
		</tr>
                <tr>
			<th valign="top">Rek. PDAM per Bulan:</th>
			<td><input type="text" name="rekPdam" class="inp-form-error" /></td>
			<td>
			<div class="error-left"></div>
			<div class="error-inner">Wajib Diisi.</div>
			</td>
		</tr>
		
	<tr>
		<th valign="top">Alasan Pengajuan:</th>
		<td><textarea rows="" cols="" name="alasanPengajuan" class="form-textarea"></textarea></td>
		<td></td>
	</tr>
	<tr>
	<th>Upload KTP/KTM:</th>
	<td><input type="file" class="file_1" name="ktp"/></td>
	<td>
	<div class="bubble-left"></div>
	<div class="bubble-inner">JPEG, GIF 5MB max per image</div>
	<div class="bubble-right"></div>
	</td>
	</tr>
	<tr>
	<th>Upload Rek. Listrik:</th>
	<td>  <input type="file" class="file_1"  name="listrik"/></td>
	<td><div class="bubble-left"></div>
	<div class="bubble-inner">JPEG, GIF 5MB max per image</div>
	<div class="bubble-right"></div></td>
	</tr>
	<tr>
	<th>Upload Rek. PDAM:</th>
	<td><input type="file" class="file_1"  name="pdam"/></td>
	<td><div class="bubble-left"></div>
	<div class="bubble-inner">JPEG, GIF 5MB max per image</div>
	<div class="bubble-right"></div></td>
	</tr>
        <tr>
	<th>Upload Transkrip IPK:</th>
	<td><input type="file" class="file_1"  name="ipk"/></td>
	<td><div class="bubble-left"></div>
	<div class="bubble-inner">JPEG, GIF 5MB max per image</div>
	<div class="bubble-right"></div></td>
	</tr>
	<tr>
		<th>&nbsp;</th>
		<td valign="top">
			<input type="submit" value="" class="form-submit" />
			<input type="reset" value="" class="form-reset"  />
		</td>
		<td></td>
	</tr>
	</table>
                    </form>
	<!-- end id-form  -->

	</td>
	<td>

	
</td>
</tr>
<tr>
<td><img src="images/shared/blank.gif" width="695" height="1" alt="blank" /></td>
<td></td>
</tr>
</table>

<div class="clear"></div>


</div>
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</td>
<td id="tbl-border-right"></td>
</tr>
<tr>
	<th class="sized bottomleft"></th>
	<td id="tbl-border-bottom">&nbsp;</td>
	<th class="sized bottomright"></th>
</tr>
</table>















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